Nasso Linda
Lakeridge Health, Whitby, Ontario.
CANNT J. 2006 Jan-Mar;16(1):20-3.
Peritonitis was a significant problem for our peritoneal dialysis patients in 2003. In January 2004, we initiated a continuous quality improvement project to address the problem. Our project took 18 months to complete. We developed many action items. Our first step was to analyze the data to ensure accuracy, and also to determine the causative organism that contributed most to the problem. The other steps we took included more education for the home dialysis nurses, creation of a home visit form, revisions to routine doctors' orders, revision of PD education tools, use of specialty materials for high-risk patients, one-time use for all drain equipment, change to peritonitis treatments and, lastly, group education for our patients. After taking all of these steps, there was no improvement to our peritonitis rates after a 12-month period. New action items were developed and included making changes to patient training and developing a home visit protocol. We also created a partnership with our local Community Care Access Centre and taught our community nurses how to help our patients with their peritoneal dialysis. It was after implementing these last changes that we noticed a significant improvement in our peritonitis rates. It was a lengthy and challenging process to go through but in the end, we are very pleased with our results. Not only has this improved the quality of our patients' lives, it has cut costs to our program, and has also helped us to expand our program significantly.
2003年，腹膜炎是我们腹膜透析患者面临的一个重大问题。2004年1月，我们启动了一个持续质量改进项目来解决这个问题。我们的项目花了18个月才完成。我们制定了许多行动项目。我们的第一步是分析数据以确保准确性，并确定对该问题贡献最大的致病微生物。我们采取的其他步骤包括为家庭透析护士提供更多培训、创建家访表格、修订常规医嘱、修订腹膜透析教育工具、为高危患者使用特殊材料、所有引流设备一次性使用、改变腹膜炎治疗方法，最后是为我们的患者提供集体教育。采取了所有这些步骤后，12个月期间我们的腹膜炎发生率没有改善。于是又制定了新的行动项目，包括改变患者培训方式和制定家访方案。我们还与当地的社区护理接入中心建立了合作关系，并教会社区护士如何帮助我们的患者进行腹膜透析。正是在实施了这些最后的改变之后，我们才注意到我们的腹膜炎发生率有了显著改善。这是一个漫长而具有挑战性的过程，但最终，我们对结果非常满意。这不仅提高了我们患者的生活质量，降低了我们项目的成本，还帮助我们大幅扩大了项目规模。
